The Third Channel-Assisted Unilateral Biportal Endoscopic Technique for Lumbar Spinal Stenosis Combined with Contralateral Disc Herniation

Summary

Here, we present the third channel-assisted UBE technique, which allows for the vertical removal of herniated disc fragments. This technique can effectively address the limitations of traditional UBE techniques. This article will systematically elaborate on this procedure.

Abstract

Unilateral biportal endoscopic (UBE) spine surgery is an emerging minimally invasive surgical (MIS) technique that has gained popularity for treating lumbar spinal stenosis, particularly in Eastern Asia. The traditional UBE technique, with two portals on one side, can achieve successful unilateral laminotomy for bilateral decompression (ULBD) and, therefore, demonstrates favorable clinical outcomes. However, in the case of lumbar spinal stenosis combined with contralateral disc herniation, it is very difficult to remove the contralateral disc herniation, especially the loose disc fragment within the deep disc. Here, a third channel of the traditional UBE technique was developed to do the discectomy within the ipsilateral endoscopic vision, with which the instruments can go vertically into the contralateral disc, allowing easy discectomy. This technique can not only achieve adequate decompression of the bilateral spinal canal but also effectively remove contralateral herniated disc fragments. This technique avoids performing another UBE procedure on the opposite side, which can potentially shorten the duration of the operation, minimize blood loss and tissue damage, and ensure sufficient neural decompression. This paper will introduce the indications and surgical operation procedures, as well as present a classical case report and follow-up data, to facilitate the application of the third channel-assisted UBE (T-UBE) technique for spine surgeons.

Introduction

In the field of spine surgery, minimally invasive spine surgical (MISS) techniques have evolved significantly in recent years, transitioning from open surgery to microscopic, microendoscopic, and endoscopic surgery. Endoscopic spine surgery is an advanced form of MISS technique that has been widely used to treat spinal diseases and achieve satisfactory clinical outcomes¹. Compared with traditional open surgery, it has the advantages of less tissue damage, less bleeding, quicker recovery, and fewer postoperative complications².

Endoscopic spine surgery can be performed using single or two port....

Protocol

The Institutional Review Board of the Third Affiliated Hospital at Sun Yat-sen University approved the protocols (ID:[2022]02-356-01). All included patients were required to sign an informed consent form.

1. Surgical indications

1. Include patients with lumbar spinal stenosis who have contra-lateral recess stenosis or disc herniation or who have contra-lateral neural compression.

2. Surgical method

1. Perfor.......

Discussion

The UBE technique is an innovative endoscopic surgery that has rapidly advanced in recent years for the treatment of spinal disorders¹². In contrast to PELD, UBE does not require specialized instruments and is similar to conventional surgical procedures. This may reduce costs and eliminate the need for extensive training, particularly for surgeons experienced in arthroscopic surgery¹³. Therefore, the UBE technique has been widely used for discectomy, spinal canal decompress.......

Materials

Name	Company	Catalog Number	Comments
Bone dissector	Hengsheng Medical Instrument Co., Ltd.	PMT-BLQ001	Used for soft tissue expansion and laminar bone surface soft tissue stripping. Curved streamline design, better hand holding, one device and two uses, one end as soft tissue expansion, the other end as bone tissue dissection, fully expand and dissect the lamina and facet soft tissue.
Electric surgical equipment for osseous tissue	Viewall	VP7110	Used to grind off vertebral plate and partial facet bone; in the device channel, it is used for processing bone tissue; grind bone tissue at high speed, without damage to soft tissues such as nerve vessel; even grind close to nerve root, without damage to nerve; it is safer and faster.
Expandable Channel	Hengsheng Medical Instrument Co., Ltd.	PMT-KZG001	Perform channel dilation
Handle of scalpel	Hengsheng Medical Instrument Co., Ltd.	PMT-DB001	Used to Install scalpel
Mouth gag	Hengsheng Medical Instrument Co., Ltd.	PMT-KKQ001	Used to handle annulus breaks prior to disc
Nerve hook	Hengsheng Medical Instrument Co., Ltd.	PMT-LG001	Used for traction of nerve root in surgery; under endoscopic surgical field, pull apart and protect nerve root in instrument channel and can simultaneously enter other instruments for processing intervertebral disc.
Nucleus pulposus forceps	Hengsheng Medical Instrument Co., Ltd.	PMT-SHQ003	Used for clamping soft tissue and nucleus pulposus tissue of intervertebral disc during operation. Different angles and sizes allow easier grasping of soft tissue in various locations during surgery, and the finger loop design is ergonomic and easy to perform, along with gunshot forceps.
Osteotome	Hengsheng Medical Instrument Co., Ltd.	PMT-GZ001	During the operation, handle the lamina and facet, osteotomes with different angles and sizes can efficiently and flexibly chisel the facet and laminar bone
Radiofrequency electrode	GAOTONG	DZX-T2430-A160	Used for hemostasis ablation, cutting and cleaning soft tissue under endoscope during operation
Rongeur	Hengsheng Medical Instrument Co., Ltd.	PMT-YGQ002	During the operation, the laminar and facet bones were bitten and cut, the bone window was enlarged, and different sizes and angles were different. The bitewing mouth of the large incision easily bitewed off different bony tissues and calcified tissues, greatly saving the operation time, gun design, better hand holding sensation, and more forceful biting of bony tissues during the operation
Scalpel	Hengsheng Medical Instrument Co., Ltd.	PMT-SSD001	Used to cut the annulus fibrosus
Tissue Liberator	Hengsheng Medical Instrument Co., Ltd.	PMT-BLQ002	Used for stripping soft tissue in surgery, bidirectionally at different angles; used for stripping and separating mucosal tissue under instrument channel.